This PPT explains about how Singapore is using IT in healthcare, Integrated Health Information Systems, Singapore's Shifting Demographics and 2020 Master Plan. For more information visit: http://www.transformhealth-it.org/
3. 3
~ 5.4 million people on 707.1 sq km (6,489/km2)
Ethnically diverse:
Chinese: 75%
Malays: 14%
Indians: 9%
Others: 2%
40,000+ healthcare providers
11,230 hospital beds
~450,000 hospital admissions
Public sector out-patient visits
Specialist Outpatient Clinics ~3.6m
A&E ~800k
Polyclinics ~4m
Singapore is a small vibrant country
4. 4
IHiS is a healthcare-IT leader, transforming patient care through excellence in technology.
Our healthcare-IT professionals architect and manage the highly integrated systems across
Singapore’s Regional Health Systems, public hospitals, national specialty centres and polyclinics.
IHIS played a key role in 7 out of 8 Singapore hospitals and 1 Primary Care facilities becoming
among the first public institutions in the Asia Pacific region to achieve HIMSS EMRAM Stage 6,
an international benchmark for advanced technology used in patient care.
IHIS works with the healthcare institutions to drive innovation so as to achieve new standards in
quality care.
Integrated Health Information Systems
6. 6
Evolution of Singapore Healthcare IT
Stand Alone
Applications
Stand Alone
Applications
Hospital Information
System and
Cluster EMR
Population based,
Lifetime Health Record,
NEHR
Patient Portal,
Personalized Health
Record
Limited Functionality Extended Functionality Full Functionality Full Functionality,
Telehealth
Full Functionality,
Home Monitoring
No interoperability Limited Interoperability,
within the Health
Institution
More
Interoperability
Across Health Clusters
Full
Interoperability,
Nation-wide
Full
Interoperability,
Home and Community
Focus:
Financial, Inventory and
Patient master Index
Focus:
Administrative, ADT,
Scheduling, Lab, Rad
and Pharmacy
Focus:
Integration of
Administrative and
Clinical
Focus:
Advance Clinical &
decision Support and
Business Intelligence
Focus:
Personal Health &
Wellness, Population
Enablement and
Advance Analytics
Patient
Master
Index
Smart
Healthcare
Health
Informatics
Electronic
Medical
Record
EMR
eHealth
8. 8
Our total fertility remains low and our life span is increasing
Population as a whole will “age” faster in the next one to two decades.
A higher proportion of Singaporeans who are 65 year old or above
By 2030, one in five of us, will be 65 years and older
Fewer Working-Age Adults to Each Citizen Aged 65 and above
Singapore’s shifting Demographics as
Singaporeans are living longer
11. 11
Overview of Public Healthcare IT
Hospitals
Information sensing
Paperless
Clinical & Business
integration
Advanced Clinical
Decision support
RH
EMR EMR
NEHR
GP CH
EMRX
Exchanges of Images, Records
Intra-Cluster
Integrated Workflow
One EMR
One Patient
Relationship
Management PRM
Cross-Cluster
One EHR
EMR for Details
12. 12
Take a System-Wide
View to Solutions
Create an Eco-System
& Culture for Solution
Re-use
Comply with Solution
Governance: Solutions
Review Board (SRB),
Process and Program
Steering Committee
(PPSC)
Better Quality,
More
Resiliency,
Fewer
Interfaces
Shorter time to
Deployment
Lower
Development &
Maintenance
Cost
Enterprise Architecture
Guidance Towards Solution Harmonisation
12
13. 13
Strategy to achieve
Non-Disruptive IT shared Services
Federated Enterprise
Architecture
PHI Operating Model
EMRs/NEHR/Clinical systems /
Master patient index
Patient Relationship Management
Connect with AIC, NH, CHs, GPs, etc
Interface through QDX
Standardize
Integrate and Optimize
Architect the
Roadmap
Integrate the
Systems
Patient
Centric
Records
14. 14
ICD 10 AM
SNOMED CT
LOINC
Structured notes
Clinical analytics
Clinical decision
support (EMRs,
NEHR)
Tele-health
Integrate
Analytics across
Continuum
Intervene
at the Right
Channels
Back to Basics
Data Standard and Right Channel
Common
Data
Standardized
20. 20
Value to Patients
• Improve patient safety through reducing
medication errors
Value to Hospitals / Staff
• Remove waste, improve system efficiency
Technology Innovation
• 1st in Asia with a complete end-to-end
closed-loop solution
Scalability
• Implemented in KKH, NUH and TTSH
• Average Unit Dose Serving / year
KKH - 3.9m of unit dose drugs for 65,000 patients
NUH - 5.5m of unit dose drugs for 92,000 patients
TTSH - 6.6m of unit dose drugs for 110,000 patients
WHY Closed Loop Medication Management
21. 21
WHAT are the CLMM components
Electronic Prescription System
• Patient’s medication prescriptions
Clinical Decision Support System (CDSS)
• Enterprise wide Business Intelligence
to support clinical care
Packaging Robot
• Unit dose Packaging
Nursing Administration System
• Bar-code technology to serve drugs
correctly
23. 23
CLMM ensure 5 RIGHTS
Right patient
Right drug
Right dose
Right route
Right time
Enhanced Medication Safety
Process
• Improve patient safety
Efficiency of ward processes
• Reduce turn around time for
medication stock
• On-time, on-demand serving
(urgent medication order)
No more faxing of prescription
• Improve the billing process
Billing is done upon medication
administration
24. 24
Lessons Learnt
• Robot technology for filling medication according to orders from EMR system
eliminate human errors and enhanced patient safety.
• The 2D barcode is capable of storing more information and also ensure higher
degree of accuracy compared to one dimensional bar code.
• If the unit dose packaged medication is not consumed or when the doctor change
the patient’s medication, it can be returned to pharmacy for the next patient.
• For the medications bundled with a ring, it helps to speed up the cart-fill and enable
the pharmacy staff to spend more time for other clinical activities.
• The robot is capable of packing mini-bottle medicine but not big bottles.
• Labeling medications with 2D barcode enables clinicians to scan and verify
medication administration at the point of care, helping to ensure the ‘5 rights’ of
medication administration.
• Filling the robot for unit dose packing has to be observed very closely for patient
safety
26. 26
Organization Support
• Effective systems to support accurate and concise documentation of practice
in medical records
• Appropriate policies and procedures in relation to effective documentation
systems, practices and management of patient health information
• The provision of adequate time allocation to document appropriately and
review previous documentation as part of patient care
Leadership
• Involve clinical staff in decision making in relation to selecting, implementing
and evaluating documentation systems
• Implementing quality improvement processes related to effective
documentation
• Promote documentation as an integral and core part of practice and
professional responsibility
Resources
• Access to an appropriate physical environment that supports and increases
efficiency and confidentiality of documentation
• Reliable, accessible and appropriately maintained equipment
EMR
Clinical Documentation Implémentation Stratégies
27. 27
• Engage all clinical chiefs and administrators
on the new clinical documentation
• Conduct roadshow for all doctors to create
awareness
• Set up ‘sandbox’ with feedback system for
clinicians to trial the new clinical documentation
• Implement clinical documentation in outpatient
settings first as it is less complex than the
inpatient settings
• Implement clinical documentation with a group of related stakeholders
• Deploy additional IT support staff on site during the rollout
EMR
Clinical Documentation Implémentation Stratégies
28. 28
Benefit of Clinical Documentation
Appropriate documentation
promotes
A high standard of clinical care
Improved communication and
dissemination of information
between
and across service providers
An accurate account of treatment,
intervention and care planning
Improved goal setting and
evaluation
of care outcomes
Improved early detection of
problems
and changes in health status
Evidence of patient care
29. 29
Challenges in Clinical Documentation
Clinicians’ Adoption
- Integrated with consultation
workflow
- Balance between Structured and
Free Text
- Minimal clicks/ data entry
- Auto-retrieved Allergy, Health
Issues,
Lab / Rad Results and Medication
- Incorporate CPOE into document
- Incorporate CDSS into document
- Short and concise printout
- Reduce duplicate entry
30. 30
Standardisation and Governance
Same Coding standards for Clinical
Decision Support and Analytics
Same Data items for same observations
in all documentation to facilitate future
analytics
e.g. Smoking History, Pain score etc
Same look & feel across institutions for
ease of use, particularly for junior
doctors rotating from institution to
institution
Challenges in Clinical Documentation
31. 31
Improve Clinician Engagement
EMR becomes a common platform for information sharing and
real-time reporting, resulting in greater communication and
partnership among different clinical teams and improved
patient outcomes.
Accountability
Demonstrates the clinician’s accountability and records their
professional practice.
Communication
The basis for communication between health professionals
about the (a) Care provided, (b) treatment, (c) Care plan,
(d) outcome
Quality
Should be clear, concise, correct, contemporaneous,
complete, collaborate, patient-focused
Confidentiality
Must maintain confidentiality
Lessons Learnt
32. 32
Data Standardization
• Adopt SNOMED-CT for
Problem List and Diagnosis
• Problem List and Diagnosis can
be set as ‘General’, ‘Chart’ and
‘Visit’.
• SNOMED-CT coded Problem
List and Diagnosis facilitates
Decision Support.
• SNOMED-CT coded Problem
List and Diagnosis assist in
Analytics
33. 33
Governance Process
Involve clinicians from all
institutions for requirement study
so that clinical notes for same
specialty are standardised across
institutions
Change Control Committee (CCC)
comprising of IT representatives
from different clinical document
teams to review data items for
new clinical document
Core Clinical Design Team (CCDT)
comprising of clinicians, nurses
and IT to review the new clinical
document
IHiS is a healthcare-IT leader, transforming patient care through excellence in technology.
Our healthcare-IT professionals architect and manage the highly integrated systems across Singapore’s Regional Health Systems, public hospitals, national specialty centres and polyclinics.
We played a key role in Seven Singapore hospitals becoming among the first public institutions in the Asia Pacific region to achieve HIMSS EMRAM Stage 6, an international benchmark for advanced technology used in patient care.
We are at the forefront of innovation, driving new standards in quality care.